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�k�� � <br />��� <br />City of Roseville <br />Finance Department, License Division <br />�,660 Civic Center Drive, Roseville, MN 55�1 � <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />;... � � � <br />Business Name •' ' �`� � '� � i � ' �� +� � r <br />� <br />Business Address <br />Business Phone <br />��nail Address <br />Person % Coniaci in Regard foBusiness License: <br />. i <br />Legal Name J;• _'_,� ,?. �� �?t��? �� <br />Address _ <br />Phone <br />Drivers License Number <br />-� <br />Date of Birth �� <br />1 hereby apply for the following license(s) for the term of one year, beginning Iuly 1, ��'G �' , and ending June <br />31, ,���_, � the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired Eee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The undersigned applicant malses this application pursuant to all the laws of the Stale of Minnesota and regulation as <br />the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue #I76.182. <br />� ' <br />�7��A�I�f4 �% � c f'-'• i `.� f � _ - <br />- i.s <br />.. .. . . ,___ ' '_�.., � � , <br />f � <br />p�ic _ _. _. t= � . �� : ,: , <br />If completed license should be mailed somewhere other than the business address, please advise. <br />